by AJ Riviezzo
We are hearing that some physicians are being told by some other physicians a new, and potentially fraudulent, process when it comes to using Varithena. They are being told they can use 1 ml of Varithena to initiate the chemical closure followed by 5 to 10 ml of physician compounded foam (PCF) using the same access point into the same vein. The codes being used to bill this are the Varithena 36465 and 36466 CPT codes.
American Physician is NOT in the business of telling physicians how to treat patients. We are, and always have been, very cautious when it comes to billing/coding that could be fraudulent.
The codes for administering PCF are 36470 and 36471 sclerotherapy. Starting a vein with Varithena and finishing with PCF feels ‘wrong’. If you are not documenting exactly what you are doing, it is most assuredly wrong. If you are documenting this and not coding it properly, we are back to it being wrong. The procedure description and reimbursement assigned to 36465/36466 includes the cost of the proprietary sclerosant. CPT states that each CPT code reported must exactly match the service performed and cannot be a ‘close apprximation’ to the selected code. Medicare and Medicare Advantage audits are becoming more and more prevalent. We do not believe the bit of cost savings is worth potentially failing an audit and being subject to recoupments, fines or worse.